Lupus, an autoimmune disease that causes the body to attack its own healthy tissue, can range greatly in severity from person to person. An estimated 1.5 million Americans are living with some form of lupus, estimates the Lupus Foundation of America. In some people, the disease can cause widespread damage to internal organs and affect every aspect of life.

When lupus causes significant limitations and you are unable to work, you might qualify for Social Security disability benefits. Below is an overview of what you need in order to meet the Social Security Administration’s (SSA) requirements for benefits. For questions about getting Social Security disability for lupus in Raleigh, call a disability lawyer at Lunn & Forro, PLLC today for a free consultation: 888-966-6566.

What do I need to meet the requirements for disability based on lupus?

Lupus is one of the conditions in the SSA’s Listing of Impairments, but it does not automatically qualify you for disability benefits. In order to qualify for benefits under the lupus listing (Section 14.02), your condition must meet the specifications in one the following two evaluation methods:

  1. Your lupus must involve two or more organs/body systems, at least one of which is considered at a moderate level of severity. You must also have at least two of the “constitutional symptoms or signs” of lupus, such as severe fatigue, fever, malaise, or involuntary weight loss.
  1. You can also qualify under the lupus listing if you have had repeated manifestations of lupus, with at least two of the constitutional symptoms or signs discussed above, and one of the following at the marked level: limitation of normal daily activities; limitation in maintaining social functioning; or limitation in completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace.

If you do not meet the criteria in the listing, you may still qualify if your lupus prevents you from working.

What are the other criteria to obtain disability benefits?

The SSA provides disability benefits only to those who are disabled and unable to work. As such, the Administration has strict criteria that applicants must meet to recover benefits. The general requirements are as follows:

  • Your condition (in this case, lupus) meets the specifications we outlined above, or
  • Your condition prevents you from working, despite adhering to the recommended treatment.
  • You cannot adjust to new work.
  • A doctor expects your condition to last a year or longer or result in death.

You must also meet other financial or work requirements depending on the type of disability benefit you are applying for.

Social Security Disability Insurance (SSDI): To qualify for this benefit, you must have earned enough work credits throughout the years. The number of credits you need depends upon your age. For example, adults under the age of 24 need only six credits, whereas someone aged 50 would need 28 credits.

Supplemental Security Income (SSI): The SSA has a secondary disability program, SSI, for those with limited resources who have never worked or who have not earned enough credits to qualify for SSDI. To qualify for SSI, your income and the value of your assets must be below a certain threshold.

What kind of evidence do I need to meet the criteria for benefits?

Medical records are the primary way to establish the evidentiary requirements for disability benefits. The first thing the SSA examiner will look for when s/he reviews your application is whether your medical records show that your lupus satisfies the criteria in the current “Criteria for the Classification of Systemic Lupus Erythematosus” by the American College of Rheumatology.

You will need to submit your records from all your treating physicians and specialists, hospital records, doctors’ notes about the treatments you have undergone, etc.

You can also ask your doctor to fill out what is called an RFC form, which assesses your “residual functional capacity.” The form gives the claims examiner an overview of what your limitations and capabilities are, which the SSA takes into consideration when determining whether it thinks you are capable of working.

The SSA denies the majority of applicants due to insufficient medical records or technical errors, according to the SSA’s Annual Statistical Report. Your evidence must be thorough, accurate, and convincing.

The SSA denied my disability claim. What do I do now?

If the SSA has denied your application for disability benefits based on lupus, you have the right to appeal your claim. Call Lunn & Forro, PLLC to speak to a lawyer about moving forward.

We will file an appeal of your denial and work with you to collect medical evidence to show that you are unable to work.

You have only 60 days from the time you received notification about the denial to file an appeal, so it is essential to be proactive and act right away.

Call our office in Raleigh today for a free, no-obligation consultation and let us get to work on pursuing the benefits you and your family need: 888-966-6566.